Incidence and risk factors for the immune reconstitution inflammatory syndrome in HIV patients in South Africa: a prospective study
Incidence and risk factors for the immune reconstitution inflammatory syndrome in HIV patients in South Africa: a prospective study
复制标题
DOI：
10.1097/qad.0b013e3282f4a607
复制
发表时间：
2008-03-12
期刊：
影响因子：
3.8
通讯作者：
Van Rie, Annelies
中科院分区：
文献类型：
--
作者：
Murdoch, David M.;Venter, Willem D. F.;Van Rie, Annelies
目的：确定南非免疫重建炎症综合征（IRIS）的发病率、临床表现、危险因素和转归。设计：在一家大型大学医院的抗逆转录病毒治疗（ART）门诊进行前瞻性监测队列和巢式病例对照研究。方法：在ART治疗的前6个月内，共有423名ART初治的HIV感染的南非患者被随访IRIS的体征和症状。结果：在ART治疗的前6个月，44例（10.4%）患者发生IRIS，总发病率为25.1例/100患者年。诊断包括结核（18/44，41%）、脓肿形成和化脓性毛囊炎（8/44，18.2%）、水痘带状疱疹（6/44，13.6%）、单纯疱疹（4/44，9.1%）、隐球菌脑膜炎（3/44，6.8%）、传染性软疣（3/44，6.8%）和卡波西肉瘤（2/44，4.5%）。IRIS发作的中位时间为ART开始后48天（四分位距，29-99）。与对照组相比，IRIS病例在基线时的CD 4细胞计数显著降低（79 vs. 142个细胞/μ l; P= 0.02）和IRIS诊断时（183对263个细胞/μ l; P= 0.05），但对ART的病毒学和免疫学反应相似。在多变量分析中，较高的基线CD 4细胞计数可保护IRIS的发展（HR 0.72/50个细胞/μ l增加）。大多数IRIS病例为轻度，3例（6.8%）患者停止ART，4例（9.1%）患者给予皮质类固醇，12例（27.3%）患者需要住院治疗。两例死亡归因于IRIS.Conclusions：IRIS可能会影响10%的患者启动ART在非洲，特别是那些先进的免疫抑制，但严重的，危及生命的IRIS是罕见的。(C)2008年威科健康Lippincott威廉姆斯&威尔金斯。
Objective: To determine the incidence, clinical manifestations, risk factors and outcome of immune reconstitution inflammatory syndrome (IRIS) in South Africa.Design: Prospective surveillance cohort and nested case-control study in a large, University hospital-based antiretroviral therapy (ART) clinic.Methods: A total of 423 ART-naive HIV-infected South African patients were followed for signs and symptoms IRIS during the first 6 months of ART. We also performed a nested case-control study with controls matched to IRIS cases on ART duration.Results: During the first 6 months of ART, 44 (10.4%) patients experienced IRIS for an overall incidence rate of 25.1 cases per 100 patient-years. Diagnoses included tuberculosis (18/44, 41%), abscess formation and suppurative folliculitis (8/44, 18.2%), varicella zoster (6/44, 13.6%), herpes simplex (4/44, 9.1%), cryptococcal meningitis (3/44, 6.8%), molluscum contagiosum (3/44, 6.8%), and Kaposi's sarcoma (2/44, 4.5%). Median IRIS onset was 48 days (interquartile range, 29-99) from ART initiation. In comparison with controls, IRIS cases had significantly lower CD4 cell counts at baseline (79 versus 142 cells/mu l; P= 0.02) and at IRIS diagnosis (183 versus 263 cells/mu l; P= 0.05), but similar virological and immunological response to ART. In multivariable analyses, higher baseline CD4 cell count was protective of developing IRIS (HR 0.72 per 50 cells/mu l increase). Most IRIS cases were mild, with ART discontinued in three (6.8%) patients, corticosteroids administered to four (9.1%) patients, and hospitalization required in 12 (27.3%) patients. Two deaths were attributable to IRIS.Conclusions: IRIS may affect 10% of patients initiating ART in Africa, particularly those with advanced immunosuppression, but severe, life-threatening IRIS is uncommon. (C) 2008 Wolters Kluwer Health Lippincott Williams & Wilkins.